Terminal, unbearably ill, or ‘just’ tired of life?

The general population supports measures for aid in dying - but what are the limits?

A number of news stories these past few days have highlighted differences between ‘right-to-die’ groups and also the myths perpetrated by the ‘pro-life’ groups. An elderly, arthritic woman dies at the Zurich assisted suicide clinic; an elderly woman being evicted with nowhere to go ends her life by suicide; a man with Alzheimers, lacking capacity, is rejected by a suicide clinic and is aided by two long time friends who provide the means.

Let’s distinguish between voluntary euthanasia – where a doctor provides the final act (such as an injection); assisted suicide – where someone provides the means (such as a drug) but the final act (swallowing it) is performed by the person concerned; and rational suicide – where a person is able to act unaided.

A lawful assisted suicide
Nan Maitland travelled to Switzerland for assisted suicide last month. She was 84 years old and described her life as “more pain than pleasure”. Anti-euthanasia campaigner Dr Peter Saunders, of Care Not Killing, said: “This case, involving an elderly woman with arthritis who was actively assisted by fellow campaigners to kill herself, yet again exposes the real agenda of the pro-euthanasia lobby . . . The true aim of those campaigning for a change in the law, as we have seen today, is to allow anyone who requests it, regardless of their age or health, to be helped to end their lives.” Palliative medicine consultant Baroness Finlay added: ”The danger is that you can make people feel they are being selfish by wanting to carry on living or by wanting to be cared for rather than ending their lives.” Both comments are clearly misrepresentations. Right-to-die societies vary considerably in their stance, and the opponents have yet to find a single case of a person ending their life because they feel they are being selfish not to. This was not someone choosing euthanasia over old age as some of the newspapers suggested. It was someone who had been active in the ‘movement’ for a long time, was very ill, and died the way she had always believed in.

A regrettable suicide
Paula Millard, who was in her 60’s, died by her own hand in the Niagara Falls area of Canada as she was being evicted with nowhere to go. No-one helped her die. She was not seriously ill. The best efforts of various support services were to no avail. Her situation is tragic. No-one in their right mind (including any right-to-die society I know of) would have assisted her to die. Perhaps there is some tiny comfort in that she died peacefully rather than throwing herself from a height. Again, she felt no desire to die in order not to be a burden – the facilities simply were not there. Cases such as Paula’s cry out not just for better suicide prevention initiatives but for emergency social care for those in need.

An illegal but understandable assisted suicide
71-year-old former Qantas pilot Graeme Wylie applied to the Swiss suicide clinic Dignitas for assistance in suicide. He was refused on grounds of his developing Alzheimers. Two long time friends obtained some lethal drugs for him and left them by his bedside. He died by his own hand. Was that wrong? If not, should the Swiss clinic have helped him? The difference here is that the friends would have knowledge of his long term wishes and perhaps have a better idea of whether he really wanted to live or die. Strangers meeting him in Zurich would not have such established knowledge. (A similar principle is in evidence in the Netherlands where a patient must be well-known to a doctor performing euthanasia – with cases of Alzheimers this is critical.)

The position of right-to-die societies
The uniting factor among right-to-die societies is not a desire to let as many people as possible die prematurely. It is to support and respect a person’s real, enduring will to live or to die. In some circumstances, this will coincide with the moral choices of persons prepared to offer assistance; in other cases, however regrettable, the person will have to make that leap themselves unaided; and in yet other cases, the support is for suicide prevention and other forms of support, including social, palliative or psychiatric, to support and enable a person’s desire to live.

Exit’s position
We support voluntary euthanasia requests by persons who, being unbearably and unrelievably ill, make a sustained and competent request. If these conditions are met, we do not discriminate between physical and mental illness, between terminal and non-terminal disease. We do not go as far as groups that support euthanasia for those who are ‘tired of life,’ whatever their rights to die by suicide might be. There is a difference between what you can do yourself and what you can reasonably ask someone else to do for you.

With assisted suicide – where a person simply provides the means but does not actively participate, maybe there is something to learn from Swiss law, that stresses that there must be no financial or selfish motive (an attitude that seems to be at least partly embodied in the Guidelines of the Director of Public Prosecutions for England & Wales).

With self-deliverance (rational suicide) we recognise that a person has to be the best judge, ultimately, of their own fate. The weight of research shows that people do not take ending their lives by suicide lightly. There is a demonstrable need for better suicide intervention programmes; but there is no evidence to suggest people would not die by suicide if good self-deliverance information on peaceful and dignified methods were not available. Nevertheless, Exit is careful about dissemination, and favours careful certain checks and balances where possible.

What can be done?
Voluntary euthanasia and assisted suicide – the Dutch, Swiss and Oregon models, for all their shortcomings, deserve to be used as inspiration for improving the situation in the UK. Occasionally only backstreet assistance works – there is an argument for civil disobedience – but in the main, proper checks, support, palliative care options and above all transparency would reduce much suffering. Exit favours a legal model that allows exceptions to the rule to be proven, as this increases safeguards, rather than blanket legislation.
Self Deliverance – methods of ending one’s own life should be researched in greater detail – this is one of Exit’s priorities. Some people are choosing dangerous methods due to lack of information or feeling scared by the insistence on special equipment by some advocates. Provision of self-deliverance information should be developed alongside suitable suicide intervention programmes – enabling those who clearly and rationally wish to die to do so peacefully and those that would really want to live to do so. Depression that is clinically determined (irrespective of unbearable illness) should be separated from depression at the thought of inevitable death – both are regrettable and possibly treatable in many cases, but success in treating depression is not necessarily connected with a revocation of one’s wish to die.

Further reading:
Woman chooses euthanasia over old age (slanted story about Nan Maitland’s death)
Body found in trailer (Paula Millard’s death)
Woman admits aiding partner’s suicide (Graeme Wylie’s death)
Being “tired of life” is not grounds for euthanasia (BMJ article / Dutch court case)
Dutch approve euthanasia for a patient with Alzheimer’s disease (BMJ article)

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